Type 2 diabetes

Type 2 diabetes, formerly known as adult-onset diabetes, usually develops after the age of 35 to 40, accounting for more than 90% of diabetic patients.

The ability to produce insulin in patients with type 2 diabetes is not completely lost. Some patients even produce too much insulin in their bodies, but the effect of insulin is poor. Therefore, insulin in patients is relatively lacking and can be stimulated by certain oral drugs The secretion of insulin. However, some patients still need insulin therapy in the later stage.

Cause

1. Genetic factors

Like type 1 diabetes, type 2 diabetes has a more obvious family history. Some of these pathogenic genes have been identified, and some are still in the research stage.

2. Environmental factors

Epidemiological studies have shown that obesity, high-calorie diets, insufficient physical activity and increased age are the most important environmental factors for type 2 diabetes. Factors such as high blood pressure and dyslipidemia also increase the risk of disease.

3. Age factor

Most type 2 diabetes develops after the age of 30. In half of newly diagnosed type 2 diabetes patients, the age at onset is 55 years or older.

4. Race factors

Compared with whites and Asians, type 2 diabetes is more likely to occur in Native Americans, African-Americans and Spanish populations.

5. Lifestyle

High-calorie intake and unreasonable structure of diet can lead to obesity. With weight gain and lack of physical exercise, insulin resistance will progressively worsen, leading to insulin secretion defects and type 2 diabetes.

The main causes of type 2 diabetes include obesity, insufficient physical activity and stress. Stress includes stress, fatigue, mental stimulation, trauma, surgery, childbirth, other major diseases, and the use of hormones that raise blood sugar. Due to the above-mentioned incentives, the patient's insulin secretion capacity and the body's sensitivity to insulin gradually decrease, and blood sugar rises, leading to diabetes.

So far, we have not been able to control the genetic factors of the human body. However, we can intervene in environmental factors to reduce the prevalence of type 2 diabetes.

Clinical manifestations

There is often a family history; it can occur at any age and is more common in adults; most of the onset is insidious, with relatively mild symptoms, only mild fatigue and thirst, and more than half have no symptoms; some patients have chronic complications, concomitant diseases or Found during physical examination.

an examination

Type 2 diabetes is caused by the inability of insulin to work effectively (the content of binding to the receptor is low). Therefore, not only fasting blood glucose should be checked, but blood glucose should be observed 2 hours after a meal, especially the islet function test.

The specific values are as follows: normal fasting blood glucose: 3.9 to 6.1 millimoles/liter, and blood glucose 2 hours after a meal below 7.8 millimoles/liter. Diabetes can be diagnosed if fasting blood glucose ≥ 7.0 mmol/L and blood glucose ≥ 11.1 mmol/L 2 hours after a meal. If the fasting blood glucose is between 6.1 and 7.0 millimoles/liter, and the blood glucose between 7.8 and 11.1 millimoles/liter 2 hours after a meal is impaired glucose regulation, it is a manifestation of early diabetes. The urine glucose test is for reference only, and cannot be used to diagnose diabetes and medication.

Islet function test: the examinee observes the changes of blood glucose, insulin, and C-peptide after oral administration of 75 grams of glucose water and 300 milliliters.

diagnosis

In July 1997, the American Diabetes Association proposed standards for the diagnosis and classification of diabetes.

1. Have symptoms of diabetes, and random blood sugar ≥ 11.1mmol/L. Random blood glucose refers to the blood glucose level at any time. Typical symptoms of diabetes include polyuria, polydipsia, and weight loss without other triggers.

2. Fasting blood glucose ≥7.0mmol/L, fasting state is defined as no calorie intake for at least 8 hours.

3. 2-hour blood glucose ≥ 11.1mmol/L in OGTT. OGTT is still conducted in accordance with WHO's requirements.

Patients who do not have symptoms of diabetes but meet one of the above criteria are diagnosed as diabetes if they still meet one of the three criteria in the next day's follow-up visit.

In the new classification criteria, diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) belong to the hyperglycemia state, and the corresponding normal blood glucose state is normal glucose regulation. The diagnostic criteria for IGT are: 2-hour blood glucose at OGTT ≥7.8 mmol/L but <11.1 mmol/L, IFG is fasting blood glucose ≥ 6.1 mmol/L but <7.0 mmol/L.

2010 ADA diagnostic criteria for diabetes:

1. Glycated hemoglobin HbA1c≥6.5%.

2. Fasting blood glucose FPG≥7.0mmol/L. Fasting is defined as no calorie intake for at least 8 hours.

3. During oral glucose tolerance test, the 2-hour blood glucose ≥ 11.1mmol/L.

4. In patients with typical symptoms of hyperglycemia or hyperglycemia crisis, random blood glucose ≥ 11.1mmol/L.

When there is no clear hyperglycemia, repeat testing should be used to verify criteria 1 to 3.

Compared with the past, there are two improvements: the increase of glycosylated hemoglobin index; the weakening of the symptom index, more people are included in the category of diabetes, and early diagnosis and treatment.

treatment

1. Oral hypoglycemic drugs

(1) Biguanides (such as metformin) These drugs have the ability to reduce the output of glucose from the liver, and can help muscle cells, fat cells and liver absorb more glucose from the blood, thereby reducing blood sugar levels.

(2) Sulfonylureas (such as glimepiride, glibenclamide, gliclazide, and gliquidone). The main effect of these oral hypoglycemic drugs is to stimulate the pancreatic islets to release more insulin.

(3) Thiazolidinediones (such as rosiglitazone and pioglitazone) These drugs can enhance insulin sensitivity and help muscle cells, fat cells and liver absorb more blood glucose. However, rosiglitazone may increase the risk of heart disease.

(4) Benzoic acid derivatives (such as repaglinide and nateglinide) The mechanism of action of these drugs is similar to that of sulfonylureas, mainly to stimulate the pancreas to produce more insulin to lower blood sugar.

(5) α-Glucosidase inhibitors (such as acarbose and voglibose). This type of hypoglycemic drugs can inhibit the absorption of sugars in the human digestive tract, and the main effect is to reduce postprandial blood sugar.

2. Insulin drugs

If you still can't control blood sugar well by changing your lifestyle and using oral hypoglycemic drugs, or taking other drugs will bring you adverse effects, your doctor may recommend you to use insulin. At present, insulin cannot be taken orally and can only be injected subcutaneously using devices such as syringes or insulin pens.

Different insulin preparations have different onset time and duration of action. Patients need to choose the type of insulin suitable for their current condition under the guidance of the doctor, and set an appropriate insulin injection time.

In order to achieve the best blood sugar control effect, it is sometimes possible to premix multiple insulins before injection. Usually, the frequency of insulin injection is 1 to 4 times/day.

Through weight loss and increased exercise, some people with type 2 diabetes find that they no longer need drugs. Because they can control blood sugar through their own insulin secretion and dietary regulation when their weight reaches the ideal range.

It is still unclear whether oral hypoglycemic drugs are safe for pregnant women. Female patients with type 2 diabetes may need to stop oral hypoglycemic drugs and inject insulin during pregnancy and lactation.